Neurology December 2011 Volume 1 Issue 1

Summary: Recent evidence suggests that medically resistant epilepsy can be identified if seizures persist despite adequate doses of 2 appropriate first-line antiepileptic drugs (AEDs). Patients with medically resistant epilepsy should have their seizures carefully characterized in order to confirm their diagnosis, select treatment, and assist in determining prognosis. Patients should be counseled about factors that aggravate epilepsy and the importance of adhering to treatments. Physicians should carefully inquire about side effects and alter therapy to eliminate or minimize these symptoms. Uncontrolled seizures cause injuries, disability, and increased mortality, so surgery should be considered as soon as seizures are proven to be medically resistant. Patients with incomplete response to AEDs and who are not surgical candidates may benefit from additional medication trials or from palliative nonmedical therapies, such as vagal nerve stimulation.(C)2011AAN Enterprises, Inc.

Summary: Critical care neurology has generated interest both because of the urgency to understand acute brain injury and because acute interventions could improve outcomes. Unifying themes include intervention without delay and early recognition of the potential for deterioration of the patient. While monitoring devices offer useful prognostic indicators, conducting a thorough clinical neurologic examination is paramount in determining the most effective course of patient management. Recent progress has been made in acute brain injury monitoring, more effective reversal of anticoagulation after cerebral hemorrhage, use of hypothermia as a therapeutic intervention, and in the management of severe Guillain-Barre syndrome.(C)2011AAN Enterprises, Inc.

Summary: The change in the practice of neurology from a diagnostic to a therapeutic specialty has empowered neurologists to make increasingly important decisions and recommendations for patients. With better understanding of disease pathogenesis and treatment has come the need to focus on disease prevention and the avoidance of treatment side effects. An increasingly automated and mechanized health care system has challenged us to integrate vast amounts of data that have a direct effect on patient risks and treatment, and to develop systems that avoid medical errors and allocate resources appropriately. It is imperative that we reaffirm the wisdom of clinical experience and judgment to inform our use of new technologies lest we lose the art of listening to and caring for the patient.(C)2011AAN Enterprises, Inc.

Summary: Fingolimod is the first oral disease therapy approved for relapsing-remitting multiple sclerosis (MS). Patients can be switched directly from interferon-[beta] or glatiramer acetate to fingolimod without a washout period. Fingolimod's potent efficacy, oral route of administration, and generally good safety and tolerability make it appealing to patients and clinicians. However, several adverse effects have already been identified, overall experience with its use is limited compared to other agents, and its novel and complex mechanism of action make predicting adverse effects challenging. Fingolimod's place in the MS treatment algorithm is evolving. We anticipate that once centers have solved the logistical issues associated with fingolimod initiation and if the experience in clinical practice parallels the efficacy, safety, and tolerability demonstrated in the phase 3 trials, fingolimod's routine use will increase.(C)2011AAN Enterprises, Inc.